Adult mortality and erosion of household viability in AIDS-afflicted towns, estates, and villages in eastern Zimbabwe
Adult mortality and erosion of household viability in AIDS-afflicted towns, estates, and villages in eastern Zimbabwe
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DOI：
10.1097/01.qai.0000247230.68246.13
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发表时间：
2007-02-01
影响因子：
3.6
通讯作者：
Nyamukapa, Constance
中科院分区：
文献类型：
--
作者：
Gregson, Simon;Mushati, Phyllis;Nyamukapa, Constance
背景：家庭是撒哈拉以南非洲社会的基本社会和经济组成部分。在广泛传播的艾滋病毒流行病中，死亡率持续达到危机水平，家庭生存受到威胁。本文介绍了在小城镇，庄园，村庄在津巴布韦东部的家庭成年人死亡的影响。方法：分层基线家庭人口普查进行了，9842成年人接受了采访，检测HIV感染，并随访3年后。对于404名死亡的受访者中的374名（93%），与照顾者进行了口头尸检，并收集了有关收入损失，医疗保健和丧葬支出以及家庭解体和搬迁的数据。家庭的影响，艾滋病和非艾滋病deaths.Results：死亡发生不成比例的城市和低收入家庭，艾滋病死亡更经常导致失去户主（57%比46%，调整后的优势比[AOR] = 2.47; P = 0.003）。卫生保健和葬礼的总支出中位数分别为25美元（四分位数比率：5-88）和73美元（四分位数比率：43-128），葬礼的外部捐款数额很大（25美元，四分位数比率：10-54）。与非艾滋病死亡的家庭相比，艾滋病死亡的家庭在卫生保健方面花费更多（发病率比= 1.83; 95%置信区间：1.06至3.15），并且更频繁地解散或搬迁（39%对27%，AOR = 1.87; P = 0.038）。结论：尽管存在大家庭制度，但成年人的死亡破坏了撒哈拉以南非洲家庭的生存能力。艾滋病毒流行病大大增加了成人死亡率，艾滋病死亡尤其可能造成不稳定。
Background: Households form the basic social and economic building blocks of sub-Saharan African societies. Household viability is threatened by sustained crisis-level mortality in widely disseminated HIV epidemics. This article describes the impact of adult deaths on households in small towns, estates, and villages in eastern Zimbabwe.Methods: A stratified baseline household census was conducted, and 9842 adults were interviewed, tested for HIV infection, and followed up after 3 years. For 374 (93%) of 404 respondents who died, verbal autopsies were conducted with caregivers and data were collected on income foregone, health care and funeral expenditure, and household dissolution and relocation. The household impact of AIDS and non-AIDS deaths was compared.Results: Deaths occurred disproportionately in more urban and low-income households, with AIDS deaths more often resulting in the loss of the household head (57% vs. 46%, adjusted odds ratio [AOR] = 2.47; P = 0.003). The median gross expenditure on health care and funerals was US $25 (interquartile ratio [IQR]: 5-88) and US $73 (IQR: 43-128), respectively, with external contributions being substantial for funerals (US $25, IQR: 10-54). Households with AIDS deaths spent more on health care (incidence rate ratio = 1.83; 95% confidence interval: 1.06 to 3.15) and had more frequently dissolved or relocated (39% vs. 27%, AOR = 1.87; P = 0.038) than those with non-AIDS deaths. Households migrated disproportionately to rural villages.Conclusion: Despite the extended family system, adult deaths undermine the viability of sub-Saharan African households. HIV epidemics have greatly increased adult mortality, and AIDS deaths can be particularly destabilizing.